scholarly journals Clinical and economic impact of aliskiren in uncontrolled hypertensive patients

2012 ◽  
Vol 13 (1) ◽  
pp. 15-23
Author(s):  
Ezio Degli Esposti ◽  
Radovan Tomic
Keyword(s):  
At Risk ◽  
Economic Impact ◽  
Antihypertensive Drug ◽  
Antihypertensive Treatment ◽  
Health Benefit ◽  
Sensitivity Analyses ◽  
Societal Costs ◽  
Hypertensive Patients ◽  
Cerebrovascular Events

BACKGROUND: the majority of hypertensive patients do not achieve adequate blood pressure (BP) control and thus remain at risk of cardio-cerebrovascular events. Aliskiren, a novel antihypertensive drug acting as direct renin inhibitor, was authorized in Italy for the treatment of hypertension in patients who remain uncontrolled and at risk despite the use of at least two antihypertensive drugs. It was subject to an AIFA web-based monitoring registry. Results of the registry show a decrease of 20.8/9.2 mmHg in systolic/diastolic BP, within 6 months, when aliskiren is added to current therapy.OBJECTIVE: to evaluate the clinical and economic impact of such BP reduction in terms of avoidable cardio-cerebrovascular events.METHODS: an Excel-based Markov model compared aliskiren plus current antihypertensive treatment to current antihypertensive treatment alone over a 5-year horizon. Patients’ baseline characteristics and BP-reduction were taken from the AIFA registry and literature. Using Wilson and Anderson risk equations, the model simulated patient’s transitions from Pre-Event to Post-Event and Death, calculating the number of those who experience an event. Unit costs were assigned to treatments, events and follow-up. Sensitivity analyses considered: efficacy variability and societal costs of events.RESULTS: 2.47% of patients treated with aliskiren added-on to their antihypertensive therapy were expected to avoid an event. As observed in the AIFA registry, 19.8% of patients remained treated only with aliskiren whereas others reduced the number of antihypertensive treatments, leading to a 38.6% reduction of monthly concomitant antihypertensive treatment cost. Considering events and follow-up cost reduction, the per-patient annual incremental cost of aliskiren is calculated at € 187 and generates 0.042 QALYs over 5 years. The ICER was € 22,062 per QALY (€ 16,845 to € 30,771 for an efficacy range of ± 25%). Considering societal costs ICER was € 20,094 per QALY.Conclusions: AIFA registry real-world data confirmed aliskiren’s efficacy in uncontrolled hypertensive patients. Together with reaching their BP goals, patients consumed less medication from other antihypertensive drug classes and are expected to avoid cardio-cerebrovascular events. The ICER remained within acceptable thresholds, confirming that aliskiren represents a good investment in terms of health benefit.

Abstract 18144: Mobile Phone Text Messaging Improves Antihypertensive Drug Adherence in the Community

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Paola Varleta ◽  
Carlos Akel ◽  
Monica Acevedo ◽  
Claudia Salinas ◽  
Javier Pino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Mobile Phone ◽  
Antihypertensive Drug ◽  
Educational Level ◽  
Text Messaging ◽  
Health Concern ◽  
Drug Adherence ◽  
Hypertensive Patients

Introduction: Hypertension is a major public health concern and the leading cause of cardiovascular disease worldwide. Prevalence of adequate blood pressure control is low and it is mainly associated to poor antihypertensive drug adherence. We hypothesized that education through mobile phone text messaging (SMS) would improve antihypertensive drug adherence in hypertensive patients followed in a primary care setting. Methods: Recently diagnosed hypertensive patients receiving antihypertensive drug treatment for less than 6 months were randomised to receive SMS related to improve drug adherence and to follow a healthy life style or no messages. Exclusion criteria were history of stroke, heart failure, myocardial infarction and hemodialysis. Patients were recruited from 12 different primary care clinics in Santiago, Chile, where free antihypertensive drug therapy was provided. All patients signed an informed consent after which a survey was performed. Compliance was assessed using Morinsky- Green-Levine Questionnaire.Text messages were sent every 12± 2 days. After a 6-month follow-up, a new survey was applied. An Ordinary Least Squares regression model was used to analyse the net difference between the two groups. Results: A total of 314 subjects were recruited, mean age 60 ±10 years, 35% male, 67% with low or medium educational level (≤12 years). Mean drug pill number was 2.1 per day and the mean time of drug prescription was 4±1 months; 150 subjects were randomised to text messages. No statistical difference between the control and the intervention groups in regards to gender, age, educational level, blood pressure and baseline compliance was found. Eleven patients were lost of follow-up. Adherence in the control group decreased from to 59,7 % at baseline to 51,7% ( p<0,05) at 6 months. By contrast, in the intervention group, it increased from 50,9 % to 62,7 % ( p<0,05). The absolute difference in mean adherence rate between the two groups was 19,8 % (Standard error: 0.081, p: 0.015). Conclusion: This study shows that education through SMS in patients with recently prescribed antihypertensive drugs improved adherence to treatment. SMS could become a good and easy- to- use intervention tool to overcome low adherence to drug treatments in the community.

Abstract P139: Healthy Lifestyle Status, Antihypertensive Treatment and the Risk of Heart Failure among Finnish Men and Women

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Yujie Wang ◽  
Jaakko Tuomilehto ◽  
Pekka Jousilahti ◽  
Riitta Antikainen ◽  
Markku Mähönen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Drug Treatment ◽  
Lifestyle Intervention ◽  
Antihypertensive Drug ◽  
Antihypertensive Treatment ◽  
Healthy Lifestyle ◽  
Antihypertensive Drugs ◽  
Untreated Group ◽  
Hypertensive Patients ◽  
Antihypertensive Drug Treatment

Background: It is unclear which is more effective in preventing heart failure (HF) in hypertensive people: lifestyle intervention or antihypertensive drug treatment. Aim: To investigate whether there are differences in HF risk among hypertensive patients using antihypertensive drug treatment versus those engaging in a healthy lifestyle at baseline. Methods: Study cohorts included 38075 Finnish participants who were 25 to 74 years of age and free of HF at baseline. The study population was classified into five groups according to their blood pressure status at baseline. A healthy lifestyle was defined as having two or more healthy lifestyle factors including moderate or high level of physical activity, never smoking, body mass index <25 kg/m 2 , and vegetable consumption ≥3 times/week. Results: During a median follow-up of 14.1 years, 638 men and 445 women developed HF. Compared with normotensive people, hypertensive patients with and without antihypertensive treatment had a higher risk of HF. Engaging in a healthy lifestyle was associated with a decreased risk of HF. The multivariable-adjusted hazard ratios (HRs) of HF in the ten subgroups (normotensive group with a healthy lifestyle; hypertensive, unaware, untreated group with a healthy lifestyle; hypertensive, aware, untreated group with a healthy lifestyle; hypertensive, treated, controlled group with a healthy lifestyle; hypertensive, treated, uncontrolled group with a healthy lifestyle; normotensive group without a healthy lifestyle; hypertensive, unaware, untreated group without a healthy lifestyle; hypertensive, aware, untreated group without a healthy lifestyle; hypertensive, treated, controlled group without a healthy lifestyle; and hypertensive, treated, uncontrolled group without a healthy lifestyle) were 1.00, 1.50, 1.54, 2.24, 1.91, 2.12, 2.68, 3.05, 2.27, and 3.21 (Ptrend <0.001), respectively. Hypertensive subjects who used antihypertensive drugs but did not engage in a healthy lifestyle had a significantly higher risk of HF (HR 2.10; 95% CI 1.68–2.63) than hypertensive subjects who did not use antihypertensive drug but engaged in a healthy lifestyle. Hypertensive subjects who did not use antihypertensive drugs and did not engage in a healthy lifestyle had a significant higher risk of HF (HR 1.44; 95% CI 1.16–1.80) compared with hypertensive subjects who used antihypertensive drug and engaged in a healthy lifestyle. Conclusions: The present study demonstrates that the risk of HF was lower in hypertensive patients who engaged in a healthy lifestyle but higher in hypertensive people despite of antihypertensive drug treatment and adequate control of hypertension. Lifestyle intervention may be more effective in preventing HF than antihypertensive treatment in hypertensive subjects.

scholarly journals Cardiovascular risk and outcome in patients with hypertensive emergencies and urgencies in an emergency department. an italian greek collaboration

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.L Muiesan ◽  
M Salvetti ◽  
C Fragoulis ◽  
A Paini ◽  
F Bertacchini ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Hypertensive Emergency ◽  
Cardiac Events ◽  
Chi Square ◽  
Hypertensive Urgency ◽  
Hypertensive Patients ◽  
Hypertensive Emergencies ◽  
Cerebrovascular Events ◽  
Increased Risk

Abstract Background At present, few data are available on the prognosis of hypertensive emergencies and urgencies admitted to Emergency Departments (ED). The aim of our study was to evaluate the incidence of total and cardiovascular events during follow-up in hypertensive patients admitted in 2 ED in Italy and Greece with hypertensive emergencies or urgencies. Methods Medical records of patients aged &gt;18 yrs, admitted to the ED with blood pressure values ≥180 mmHg (SBP) and/or ≥120 mmHg (DBP) were collected and analysed (24% of patients were classified as “hypertensive emergency” and 76% as “hypertensive urgency”). Data in 1218 patients (556 men and 662 women, mean age 70±13 years) were analysed; the mean duration of follow-up after admission to the ED was 19.5±7 months years. Results During the follow-up cardiovascular events occurred in 148 patients (69 cardiac events, 43 cerebrovascular events). In 272 pts (22%) a new episode of acute BP rise was recorded. A total of 87 deaths was recorded during follow-up (in 28 patients for cardiovascular causes). All cause and CV mortality were greater in patients with a previous hypertensive emergency (14.7 vs 4.7%, chi-square p=0.0001 and 5.8 vs 1.2% chisquare p&lt;0.0001 for all-cause and for CV mortality, respectively). The incidence of non fatal cardiovascular events was 10,11 and 2,11 per 100 patient-years in patients with hypertensive emergency and urgency, respectively and similar results were obtained when we considered separately the occurrence of cerebrovascular events. Conclusions Admission to the ED for hypertensive emergencies identifies hypertensive patients at increased risk for fatal and non fatal cardiovascular events. Our results underline the need for an accurate follow-up in patients with hypertensive emergencies and urgencies. Funding Acknowledgement Type of funding source: None

P805Changes in arterial stiffness independently predict stroke in patients with essential hypertension: Data from a 8-year-follow-up study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Iliakis ◽  
C Tsioufis ◽  
K Dimitriadis ◽  
D Konstantinidis ◽  
A Kasiakogias ◽  
...  
Keyword(s):  
Cox Regression ◽  
Rapid Onset ◽  
Hazard Ratio ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
Atherosclerosis Progression ◽  
Improve Risk Stratification ◽  
Cerebrovascular Events

Abstract Background/Introduction Although arterial stiffening is related to atherosclerosis progression, the prognostic role of its alterations in cerebrovascular events in hypertension is not fully elucidated. Purpose The aim of the present study was to assess the predictive role of changes inarterial stiffness for the incidence of stroke in a cohort of essential hypertensive patients. Methods We followed up 1082 essential hypertensives (mean age 55.9 years, 562 males, office blood pressure (BP)=145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit and underwent blood sampling for assessment of metabolic profile, whilearterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method at the initial and last visit. The distribution of baseline PWV was split by the median (8.2 m/sec) and accordingly subjects were classified into those with high (n=546) and low values (n=536). Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by computed tomography and magnetic resonance angiography and/or cerebrovascular angiography findings. Results The incidence of stroke over the follow-up period was 2.2%. Hypertensives who had stroke (n=24) compared to those without stroke at follow-up (n=1058) were older at baseline (65±9 vs 56±12 years, p=0.032), had higher office BP levels (155±13 vs 145±15mmHg, p=0.014) and prevalence of high PWV levels (67% vs 40%, p=0.021). No difference was observed between hypertensives with stroke and those without stroke with respect to baseline renal function and lipid levels (p=NS for all). By univariate Cox regression analysis it was revealed that changes in PWV levels between baseline and last visit predicted stroke (hazard ratio=1.352, p=0.004). Moreover, in multivariate Cox regression model, baseline age (hazard ratio=1.087, p=0.03), changes in PWV (hazard ratio=1.115, p=0.024) but not changes in office BP levels turned out to be independent predictors of stroke. Conclusions In essential hypertensive patients, changes in PWV predict future development of stroke, independently of established confounders, including BP. These findings support that PWV constitutes a potent prognosticator of cerebrovascular events and its estimation is essential in order to improve risk stratification in hypertension.

scholarly journals QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

2020 ◽  
Vol 9 (1) ◽  
pp. 220
Author(s):  
Andrea Buono ◽  
Annika Mühlenhaus ◽  
Tabitha Schäfer ◽  
Ann-Kristin Trieb ◽  
Julian Schmeißer ◽  
...  
Keyword(s):  
Coronary Vessels ◽  
Sensitivity Analyses ◽  
Significant Stenosis ◽  
Cerebrovascular Events ◽  
Long Term Follow Up ◽  
Angiographic Evidence ◽  
Quantitative Flow Ratio ◽  
Post Hoc

AIMS: We evaluate feasibility and reproducibility of post hoc quantitative flow ratio (QFR) measurements and their prognostic predictive power during long-term follow-up. METHODS AND RESULTS: Between 2010 and 2012, 167 patients without angiographic evidence of significant stenoses were enrolled in a prospective registry. Of these patients, 96% presented 7 years follow-up data. QFR was measured post hoc by three certified investigators. QFR analysis was feasible in 71% of left anterior descending (LAD), 72% of left circumflex (LCX), and 61% of right (RCA) coronaries for a total of 350 measurements repeated in triplicate. Coefficients of variation were 2.1% for RCA and LCX, and 2.8% for the LAD (quartile coefficients of dispersion respectively 1.5, 1.4, and 1.3). QFR ≤0.80 was recorded in 25 patients (27 vessels, in 74% of the cases LAD). A total of 86 major adverse cardiovascular and cerebrovascular events were observed in 76 patients. QFR ≤0.80 in at least one of the three vessels was the strongest predictor of events (HR 3.14, 95%CI 1.78–5.54, p = 0.0001). This association was maintained in several sensitivity analyses. CONCLUSIONS: QFR reproducibility is acceptable, even when analysis is performed post hoc. A pathological QFR is not rare in patients without angiographic evidence of significant stenosis and is a predictor of incident events during long-term follow-up. Condensed Abstract: In a post hoc analysis of 167 patients without evidence of angiographic significant stenosis, the presence of QFR value ≤0.80 in at least one of the three coronary vessels showed to be the strongest predictor of major adverse cardiovascular and cerebrovascular events during long-term follow-up. QFR reproducibility have been shown to be acceptable among experienced operators.

Low-income minority women at risk for cervical cancer: a process to improve adherence to follow-up recommendations

2001 ◽  
Vol 116 (6) ◽  
pp. 608-616 ◽  
Author(s):  
Virginia A Cardin ◽  
Richard M Grimes ◽  
Zhi Dong Jiang ◽  
Nancy Pomeroy ◽  
Luther Harrell ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
At Risk ◽  
Low Income ◽  
Minority Women

Postural Changes in Essential Hypertension under Treatment and their Effect on the Renogram

1971 ◽  
Vol 10 (01) ◽  
pp. 39-46
Author(s):  
C. Alexandrou ◽  
E. Papadakis ◽  
E. Gyftaki ◽  
J. Darsinos
Keyword(s):  
Renal Function ◽  
Essential Hypertension ◽  
Early Diagnosis ◽  
Postural Hypotension ◽  
Antihypertensive Treatment ◽  
Normal Subjects ◽  
Upright Position ◽  
Postural Changes ◽  
Significant Impairment

SummaryRadioisotope renograms were obtained in the upright and prone position in 9 normal subjects, in 5 patients with untreated essential hypertension and in 21 hypertensives under treatment, showing moderate postural hypotension.No significant renographic change were seen in the two positions in normal subjects and untreated hypertensives. Treated hypertensives with postural hypotension showed significant impairment of renal function in the upright position in 15 cases and no change in 6. Renal creatinine clearance was lower in the group that showed renographic changes. Renography in the upright position is suggested as a convenient test for early diagnosis and follow-up of the adverse effects of antihypertensive treatment.

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